Carbohydrate supplementation stabilises plasma sodium during training with high intensity.

BACKGROUND: Investigations of the effect of beverages containing carbohydrates, only, on the sodium and fluid balance during intermittent exercise of high intensity are rare. Therefore, we compared the effects of water and carbohydrate supplementation on plasma, blood volume, and electrolyte shifts during intermittent exercise. METHODS: Ten male subjects performed an intermittent exercise test twice. In one trial, tap water (4 ml/kg/15 min) was consumed (Plac trial). In the other trial, the same amount of water supplemented with maltodextrin to achieve a 9.1 % carbohydrate solution (CHO trial) was ingested. Training schedule: warm-up at 50 % for 15 min. Afterwards, power changed between 100 % of the maximum power from a previous incremental test minus 10 and 10 W for each 30 s. Venous blood was sampled to measure electrolytes, osmolality, [protein], hct, [Lactate], [glucose], [Hb] and catecholamines. Hydration status was evaluated by BIA before and after exercise. RESULTS: After beverage ingestion [glucose] was significantly higher in CHO until the end of the trial. Starting with similar resting values, osmolality increased significantly more during CHO (p = 0.002). PV decreased by 5 % under both conditions, but recovered partly during exercise under Plac (p = 0.002). [Na+] and [Cl(-)] decreased with Plac during exercise (both p < 0.001) but remained constant during exercise with CHO. CONCLUSIONS: Sole carbohydrate supplementation seems to stabilise plasma [Na+]. This cannot be explained simply by a cotransport of glucose and [Na+], because that should lead to a recovery of the blood and plasma volume under CHO. In contrast, this was found during exercise with Plac.

Musculoskeletal effects of 5 days of bed rest with and without locomotion replacement training.

OBJECTIVES: The present study evaluated the effectiveness of a short and versatile daily exercise regime, named locomotion replacement training (LRT), to maintain muscle size, isometric strength, power, and endurance capacity of the leg muscles following 5 days of head-down tilt (HDT) bed rest. METHODS: 10 male subjects (age 29.4 ± 5.9 years; height 178.8 ± 3.7 cm; body mass 77.7 ± 4.1 kg) performed, in random order, 5 days of 6° head-down tilt bed rest (BR) with no exercise (CON), or BR with daily 25 min of upright standing (STA) or LRT. RESULTS: Knee extensor and plantar flexor cross-sectional area (CSA) were reduced by 2-3 % following bed rest (P < 0.01) for CON and STA, yet maintained for LRT. Knee extensor isometric strength (MVC) decreased by 8 % for CON (P < 0.05), was maintained for STA, and increased with 12 % for LRT (P < 0.05). Plantar flexor MVC remained unaltered during the study. Maximum jump height declined (~1.5 cm) for all conditions (P < 0.001). Neural activation and knee extensor fatigability did not change with bed rest. Bone resorption increased during BR and neither LRT nor STA was able to prevent or attenuate this increase. CONCLUSION: LRT was adequate to maintain muscle size and to even increase knee extensor MVC, but not muscle power and bone integrity, which likely requires more intense and/or longer exercise regimes. However, with only some variables showing significant changes, we conclude that 5 days of BR is an inadequate approach for countermeasure assessments.

The influence of respiratory acid-base changes on muscle performance and excitability of the sarcolemma during strenuous intermittent hand grip exercise.

Acidification has been reported to provide protective effects on force production in vitro. Thus, in this study, we tested if respiratory acid-base changes influence muscle function and excitability in vivo. Nine subjects performed strenuous, intermittent hand grip exercises (10 cycles of 15 s of work/45 s of rest) under respiratory acidosis by CO(2) rebreathing, alkalosis by hyperventilation, or control. The Pco(2), pH, K(+) concentration ([K(+)]), and Na(+) concentration were measured in venous and arterialized blood. Compound action potentials (M-wave) were elicited to examine the excitability of the sarcolemma. The surface electromyogram (EMG) was recorded to estimate the central drive to the muscle. The lowest venous pH during the exercise period was 7.24 ± 0.03 in controls, 7.31 ± 0.05 with alkalosis, and 7.17 ± 0.04 with acidosis (P < 0.001). The venous [K(+)] rose to similar maximum values in all conditions (6.2 ± 0.8 mmol/l). The acidification reduced the decline in contraction speed (P < 0.001) but decreased the M-wave area to 73.4 ± 19.8% (P < 0.001) of the initial value. After the first exercise cycle, the M-wave area was smaller with acidosis than with alkalosis, and, after the second cycle, it was smaller with acidosis than with the control condition (P < 0.001). The duration of the M-wave was not affected. Acidification diminished the reduction in performance, although the M-wave area during exercise was decreased. Respiratory alkalosis stabilized the M-wave area without influencing performance. Thus, we did not find a direct link between performance and alteration of excitability of the sarcolemma due to changes in pH in vivo.

The hematocrit paradox--how does blood doping really work?

The wide-spread assumption that doping with erythropoietin or blood transfusion is only effective by increasing arterial blood O2 content because of rising hematocrit is not self-evident. "Natural blood dopers" (horses, dogs) increase both hematocrit and circulating blood volume during exercise by releasing stored erythrocytes from the spleen. Improvement of aerobic performance by augmenting hemoglobin concentration may be expected until the optimal hematocrit is reached; above this value maximal cardiac output declines due to the steep increase of blood viscosity. Therefore an enlarged blood oxygen content might only be useful if the normal hematocrit of man during exercise is suboptimal. However, recent studies suggest that cardiac power rises after erythropoietin allowing an unchanged cardiac output in spite of increased viscosity. Other factors underlying improved performance after blood doping might be: augmented diffusion capacity for oxygen in lungs and tissues, increased percentage of young red cells with good functional properties (after erythropoietin), increased buffer capacity, increase of blood volume, vasoconstriction, reduced damage by radicals, mood improvement by cerebral effects of erythropoietin. Also the importance of placebo is unknown since double-blind studies are rare. It is suggested that blood doping has multifactorial effects not restricted to the increase in arterial oxygen content.

Local and systemic effects on blood lactate concentration during exercise with small and large muscle groups.

To evaluate the relationship between lactate release and [lac](art) and to investigate the influence of the catecholamines on the lactate release, 14 healthy men [age 25+/-3 (SE) year] were studied by superimposing cycle on forearm exercise, both at 65% of their maximal power reached in respective incremental tests. Handgrip exercise was performed for 30 min at 65% of peak power. In addition, between the tenth and the 22nd minute, cycling with the same intensity was superimposed. The increase in venous lactate concentration ([lac](ven)) (rest: 1.3+/-0.4 mmol.l(-1); 3rd min: 3.9+/-0.8 mmol.l(-1)) begins with the forearm exercise, whereas arterial lactate concentration ([lac](art)) remains almost unchanged. Once cycling has been added to forearm exercise (COMB), [lac](art) increases with a concomitant increase in [lac](ven) (12th min: [lac](art), 3.2+/-1.3 mmol.l(-1); [lac](ven), 5.7+/-2.2 mmol.l(-1)). A correlation between oxygen tension (P(v)O(2)) and [lac](ven) cannot be detected. There is a significant correlation between [lac](art) and norepinephrine ([NE]) (y=0.25x+1.2; r=0.815; p<0.01) but no correlation between lactate release and epinephrine ([EPI]) at moderate intensity. Our main conclusion is that lactate release from exercising muscles at moderate intensities is neither dependent on P(v)O(2) nor on [EPI] in the blood.

Extracellular pH defense against lactic acid in normoxia and hypoxia before and after a Himalayan expedition.

The extracellular pH defense against the lactic acidosis resulting from exercise can be estimated from the ratios -delta[La].delta pH-1 (where delta[La] is change in lactic acid concentration and delta pH is change in pH) and delta[HCO3-].delta pH-1 (where delta[HCO3-] is change in bicarbonate concentration) in blood plasma. The difference between -delta[La].delta pH-1 and delta[HCO3-].delta pH-1 yields the capacity of available non-bicarbonate buffers (mainly hemoglobin). In turn, delta[HCO3-].delta pH-1 can be separated into a pure bicarbonate buffering (as calculated at constant carbon dioxide tension) and a hyperventilation effect. These quantities were measured in 12 mountaineers during incremental exercise tests before, and 7-8 days (group 1) or 11-12 days (group 2) after their return from a Himalayan expedition (2800-7600 m altitude) under conditions of normoxia and acute hypoxia. In normoxia -delta[La].delta pH-1 amounted to [mean (SEM)] 92 (6) mmol.l-1 before altitude, of which 19 (4), 48 (1) and 25 (3) mmol.l-1 were due to hyperventilation, bicarbonate and non-bicarbonate buffering, respectively. After altitude -delta[La].delta pH-1 was increased to 128 (12) mmol.l-1 (P < 0.01) in group 1 and decreased to 72 (5) mmol.l-1 in group 2 (P < 0.05), resulting mainly from apparent large changes of non-bicarbonate buffer capacity, which amounted to 49 (14) mmol.l-1 in group 1 and to 10 (2) mmol.l-1 in group 2. In acute hypoxia the apparent increase in non-bicarbonate buffers of group 1 was even larger [140 (18) mmol.l-1]. Since the hemoglobin mass was only modestly elevated after descent, other factors must play a role. It is proposed here that the transport of La- and H+ across cell membranes is differently influenced by high-altitude acclimatization.

Evaluation of noninvasive determinants for capillary leakage syndrome in septic shock patients.

OBJECTIVE: Capillary leakage syndrome (CLS) is a frequent complication in sepsis, characterized by loss of intravasal fluids leading to generalized edema and hemodynamic instability despite massive fluid therapy. In spite of its importance no standardized diagnostic criteria are available for CLS. DESIGN: Prospective clinical study. SETTING: 1,800-bed university hospital PATIENTS: Six septic shock patients with CLS were compared to six control patients. MEASUREMENTS AND RESULTS: CLS was clinically determined by generalized edema, positive fluid balance, and weight gain. Plasma volume was measured by indocyanine green, red blood cell volume by chromium-51 labeled erythrocytes, and colloid osmotic pressure before and 90 min after the administration of 300 ml 20% albumin. Extracellular water (ECW) was measured using the inulin distribution volume and bioelectrical impedance analysis. Red blood cells averaged 20.2 +/- 1.0 ml/ kg body weight in CLS patients and 23.3 +/- 4.1 in controls. ECW was higher in CLS patients than in controls (40.0 +/- 6.9 vs. 21.7 +/- 3.71; p< 0.05). ECW of inulin was correlated with that measured by bioelectrical impedance analysis (r = 0.74, p< 0.01). The increase in colloid osmotic pressure over the 90 min was less in CLS patients than in controls (1.1 +/- 0.3 vs. 2.8 +/- 1.3 mmHg;p< 0.05). CONCLUSION: These results suggest that measurements of an increased ECW using bioelectrical impedance analysis combined with a different response of colloid osmotic pressure to administration of albumin can discriminate noninvasively between patients with and those without CLS.

Carbon dioxide storage and nonbicarbonate buffering in the human body before and after an Himalayan expedition.

Before and 7-12 days after an Himalayan expedition CO2 equilibration curves were determined in the blood plasma of 12 mountaineers by in vitro and in vivo CO2 titration; in vivo osmolality changes (delta Osm x deltaPCO2(-1), deltaOsm x delta pH(-1), where PCO2 is the partial pressure of CO2) during the latter experiments yielded estimates of whole body CO2 storage. In vitro -delta[HCO3-] x delta pH(-1) [nonbicarbonate buffer capacity (beta) of blood] was increased 7 days after descent [before 31.3 (SEM 0.4) mmol x kgH2O(-1), after 38.3 (SEM 3.9) mmol x kgH2O(-1); P<0.05] resulting from an increased proportion of young erythrocytes; in additional experiments an augmented beta was found in young (low density cells) compared to old cells [<1.097 g x ml(-1): 0.216 (SEM 0.028) mmol x gHb(-1), >1.100 g x ml(-1): 0.145 (SEM 0.013) mmol x gHb(-1), where Hb is haemoglobin; P < 0.02]. In spite of increased Hb mass in vivo delta[CO2total] x deltaPCO2(-1) [0.192 (SEM 0.010) mmol x kgH2O(-1) x mmHg(-1)] and -delta[HCO3-] x delta pH(-1) [17.9 (SEM 1.0) mmol x kgH2O(-1)] as indicators of extracellular beta rose only slightly after altitude (7 days +16%, P<0.02; +7%, NS) because of haemodilution. The deltaOsm x deltaPCO2(-1) [0.230 (SEM 0.015) mosmol x kgH2O(-1) x mmHg(-1)] remained unchanged. Prealtitude differences in deltaOsm x delta pH(-1) between hypercapnia [-41 (SEM 5) mosmol x kgH2O(-1)] and hypocapnia [-20 (SEM 3) mosmol x kgH2O(-1); P<0.01] disappeared temporarily after return since the former slope was reduced. The high value during hypercapnia before ascent probably resulted from mechanisms stabilizing intracellular pH during moderate hypercapnia which were attenuated after descent.

High-energy-phosphates measured by 31P-MRS during LBNP in exercising human leg muscle.

Subatmospheric pressure applied to the human body from the iliac crest caudally (Lower Body Negative Pressure, LBNP) has been known to cause various central and peripheral cardiovascular reactions. We investigated the effects of such a LBNP maneuver on energy metabolism of human skeletal leg muscle. We tested the hypothesis whether an altered fluid distribution induced by LBNP may cause any effect on aerobic and/or anaerobic energy metabolism and cellular pH-regulation during isometric contraction monitored by 31P-MRS.

[Effect of high performance sports on energy metabolism]. / Einfluss von Leistungssport auf das Stoffwechselverhalten des Körpers.

The knowledge about metabolism and muscular fatigue has been considerably improved during the recent years. Intramuscular pH should not generally be discussed as a factor of cellular fatigue as it has been shown to increase transiently at the beginning and to be very differently affected in ST-(6,9) and FT-fibers (6,2) at the end of exercise. During maximum exercise, we assume changes of muscle membrane potential due to increasing interstitial potassium concentrations as an important performance-limiting factor. The role, lactate is playing during exercise, has to be thought over. Its production by the binding of two protons to the pyruvate molecule is necessary for an intensive anaerobic and aerobic metabolism. The lactate molecules itself represent a source of energy, which is preferentially used by the heart muscle and by ST-fibers working at lower intensity. During long term endurance events, the glycogen stores are assumed to be a limiting factor. However, no direct casual relationship between glycogen and fatigue mechanisms has been found hithertoo. The anaerobic glycolytic metabolism decreases during long lasting exercise as a result of lowered glycogen stores. Therefore, metabolic acidosis cannot be observed after ultra-long endurance events. In contrast, a respiratory alcalosis is the common finding.

Red blood cells do not contribute to removal of K+ released from exhaustively working forearm muscle.

K+ released from exercising muscle via K+ channels needs to be removed from the interstitium into the blood to maintain high muscle cell membrane potential and allow normal muscle contractility. Uptake by red blood cells has been discussed as one mechanism that would also serve to regulate red blood cell volume, which was found to be constant despite increased plasma osmolality and K+ concentration ([K+pl]). We evaluated exercise-related changes in [K+pl], pH, osmolality, mean cellular Hb concentration, cell water, and red blood cell K+ concentration during exhaustive handgrip exercise. Unidirectional 86Rb+ (K+) uptake by red blood cells was measured in media with elevated extracellular K+, osmolarity, and catecholamines to simulate particularly those exercise-related changes in plasma composition that are known to stimulate K+ uptake. During exercise [K+pl] increased from 4.4 +/- 0.7 to 7.1 +/- 0.5 mmol/l plasma water and red blood cell K+ concentration increased from 137.2 +/- 6.0 to 144.6 +/- 4.6 mmol/l cell water (P

Is urodilatin the missing link in exercise-dependent renal sodium retention?

The purpose of the present study was to investigate the behavior of plasma atrial natriuretic peptide [ANP-(99-126)] concentration ([ANP]) and renal urodilatin [Uro; ANP-(95-126)] excretion during and after exercise and their possible effects on renal Na+ retention. Ten male subjects performed a cycle ergometer test for 60 min at 60% of maximum workload. Blood and urine samples were collected before, during, and up to 24 h after exercise. During exercise, plasma [ANP] and renal Uro excretion were oppositely affected: whereas [ANP] increased from 46.5 +/- 5.1 to 124.1 +/- 10.6 pg/ml, urinary Uro excretion decreased from 120.8 +/- 16.0 to 49.5 +/- 9.8 fmol/min and remained at a lower level until 1 h after exercise. Glomerular filtration rate showed lowest values during exercise (from 164.9 +/- 15.3 to 75.8 +/- 10.1 ml/min), and urine flow and the fractional excretion rate of Na+ (FENa+) and Cl- (FECl-) had their nadir during the first hour after exercise. Positive relationships were observed between Uro excretion and FENa+ (P < 0.05) and FECl-, whereas a tendency toward a negative correlation was obtained between [ANP] and FENa+. It seems possible that Uro may be, among other factors, involved in the exercise-related regulation of renal Na+ retention. The specific roles Uro and ANP play during exercise, however, remain to be investigated.

After-effects of a high altitude expedition on blood.

The aim of the study was to investigate blood alterations caused by altitude acclimatization which last more than few days after return and might play a role for exercise performance at sea level. Measurements were performed in 12 mountaineers before, during and either 7/8 or 11/12 days after a Himalaya expedition (26-29 days at 4900 to 7600 m altitude). [Erythropoietin] rose only temporarily at altitude (max. +11 +/- 1 [SE] mu/ml serum). After return hemoglobin mass (initially 881 +/- 44 g, CO-Hb method) was increased by 14% (p < 0.01); aspartate aminotransferase activity in erythrocytes (initially 682 +/- 25 U/l) was augmented (day 7: +964 +/- 152 U/l, day 11: +533 +/- 107 U/l) indicating reduced mean cell age. Calculated blood volume (+14%) was influenced by red cell formation at altitude but also by plasma expansion at sea level. The half saturation pressure for Hb-O2 (pH 7.4, 37 degrees C) as well as the 2.3-diphosphoglycerate concentration were already initially high (32.1 +/- 0.5 mmHg, 20.5 +/- 0.7 mumol/g Hb) and showed only a nonsignificant tendency to increase after return. Also Hill's n was consistently high in the mountaineers, whereas the Bohr coefficients were slightly increased only after descent. Probably the preparatory physical training, partly in the Alps, and the stay in the Himalaya influenced O2-affinity for a prolonged time. The adaptations might reduce the loss of physical performance capacity at altitude and be part of altitude training effects.

Lung diffusion capacity, oxygen uptake, cardiac output and oxygen transport during exercise before and after an himalayan expedition.

Studies were made of pulmonary diffusion capacity and oxygen transport before and after an expedition to altitudes at and above 4900 m. Maximum power (Pmax) and maximal oxygen uptake (VO2max) were measured in 11 mountaineers in an incremental cycle ergometer test (25W.min-1) before and after return from basecamp (30 days at 4900 m or higher). In a second test, cardiac output (Qc) and lung diffusion capacity of carbon monoxide (DL,cg) were measured by acetylene and CO rebreathing at rest and during exercise at low, medium and submaximal intensities. After acclimatization, VO2max and Pmax decreased by 5.1% [from 61.0 (SD 6.2) to 57.9 (SD 10.2) ml.kg-1, n.s.] and 9.9% [from 5.13 (SD 0.66) to 4.62 (SD 0.42) W.kg-1, n.s.], respectively. The maximal cardiac index and DL,cg decreased significantly by 15.6% [14.1 (SD 1.41) 1.min-1.m-2 to 11.9 (SD 1.44)1.min-1.m-2, P < 0.05] and 14.3% [85.9 (SD 4.36) ml.mmHg-1. min-1 to 73.6 (SD 15.2) ml.mmHg-1.min-1, P < 0.05], respectively. The expedition to high altitude led to a decrease in maximal Qc, oxygen uptake and DL,cg. A decrease in muscle mass and capillarity may have been responsible for the decrease in maximal Qc which may have resulted in a decrease of DL,cg and an increase in alveolar-arterial oxygen difference. The decrease in DL,cg especially at lower exercise intensities after the expedition may have been due to a ventilation-perfusion mismatch and changes in blood capacitance. At higher exercise intensities diffusion limitation due to reduced pulmonary capillary contact time may also have occurred.

Reduction of oxylabile CO2 in human blood by lactate.

The influence of lactic acid, hydrochloric acid, and sodium lactate addition (10 mmol/l each) on oxylabile CO2 was investigated in blood of male subjects after equilibration at 37 degrees C with 3, 6, and 10% CO2 in N2 and O2, respectively. The total CO2, pH in whole blood and erythrocytes, oxygen saturation, hemoglobin concentration, and hematocrit value were measured. With these data we calculated bicarbonate and carbamate concentrations and the corresponding differences between oxygenated and deoxygenated blood. The amount of oxylabile bicarbonate was not systematically influenced by the various experimental conditions. The carbamate content, however, was larger in deoxygenated than in oxygenated blood (up to 0.08 mol/mol hemoglobin) only in the absence of lactate. In the presence of lactic acid as well as sodium lactate, the carbamate content in oxygenated blood was higher by 0.06-0.13 mol/mol hemoglobin than in deoxygenated blood. The lactate effect even increased after 2,3-diphosphoglycerate depletion. We suggest, therefore, a competition between CO2 and the lactate ion at the NH2-terminal valine of the beta-globin chain in deoxygenated hemoglobin.

Relationship between plasma potassium and ventilation during successive periods of exercise in men.

During and after two successive incremental cycle ergometer tests (tests A and B), plasma potassium concentration ([K+]p), plasma pH (pHp), plasma partial pressure of carbon dioxide, blood lactate concentration ([Lac-]b) and ventilation (VE) were measured. While there was a good correlation between the increase in [K+]p and VE or pHp, respectively, in test A, in test B a close correlation was found only between the increase in VE and [K+]p (r greater than 0.9 for nearly all single cases; r was 0.84 and 0.89 for all (pooled) cases in tests A and B, respectively; the correlation coefficients between changes in pHp and VE in tests A and B were r = 0.74 and r = 0.28, respectively, and r = 0.89 and r = 0.10 between the changes in [Lac-]b and VE in tests A and B). The close relationship for individuals between VE and [K+]p in tests A and B supported the hypothesis that the extracellular increase in [K+] may contribute to the ventilatory drive during exercise. The comparison of the results of tests A and B further indicated that the relationship between pHp and VE was dependent on the experimental design, and that pHp and VE changes are unlikely to be cause and effect.

Plasma potassium and ventilation during incremental exercise in humans: modulation by sodium bicarbonate and substrate availability.

It has recently been demonstrated that, compared to normal conditions, ventilation (VE) was increased during exercise after glycogen depletion, in spite of a marked increase in plasma pH (pHP). It was further demonstrated that VE in patients with McArdle's syndrome was reduced when substrate availability was improved. In the present experiments, six endurance trained men performed two successive cyclo-ergometric incremental exercise tests (tests A, B) after normal nutrition (N) and after a fatty meal in conjunction with a sodium bicarbonate (NaHCO3) solution (FSB) or without NaHCO3 (F), and the relationship between VE, plasma potassium concentration ([K+]P), and pHP was checked. Plasma free fatty acid concentration ([FFA]P) was markedly increased in the F and FSB trials (P < 0.001). In FSB pHP was significantly increased, compared to N and F (P < 0.001). In all the B tests, pHP increased during moderate and intense exercise and in FSB, remained alkalotic even during maximal exercise intensity. In contrast, VE and [K+]P changes were almost equal in all the trials and in tests A and B. It was found that exercise-induced changes of VE and [K+]P in the present experiments were not markedly affected by [FFA]P or pHP values and that these changes also occurred independently of changes in pHP or plasma bicarbonate concentration. The often used glycogen depletion strategy may have slightly increased VE but apparently did not overcompensate for a possible decrease in VE due to increased pHP.(ABSTRACT TRUNCATED AT 250 WORDS)

Relation between plasma K+ and ventilation during incremental exercise after glycogen depletion and repletion in man.

1. We have examined the relationship between expiratory ventilation (VE), plasma potassium concentration ([K+]P), blood lactate concentration ([Lac-]B), and plasma pH (pHP) in five trained men before and after glycogen depletion and repletion in two successive incremental bicycle ergometer tests (tests A and B). 2. Though pHP was significantly higher after glycogen depletion (in relation to normal or repleted conditions) VE and [K+]P also tended to be higher. 3. There was no constant relation between the magnitude or the direction of change in lactic acidosis, or VE and [K+]P, respectively. Instead, a close temporal relationship between changes in VE and [K+]P was found. 4. A non-linear increase in VE occurred independently of changes in pHP or [Lac-]B, but could be well predicted from a non-linear increase in [K+]P. 5. These findings indicate that lactic acidosis had no deciding effect on exercise ventilation in these experiments. They are consistent with the idea that the potassium increase may contribute to the ventilatory drive during exercise.